Part B Insider (Multispecialty) Coding Alert
Physician's Assistant Accused of Ordering Unnecessary Tests That Clinic Fraudulently Billed to Medicare
Plus: CMS clarifies RAC discussion period vs. rebuttal/redetermination process The Dept. of Justice not only caught a practice with its hand in the till -- it found the practice stuffing the till with Medicare dollars. On July 22, the DOJ announced that it unsealed a 17-count indictment against four employees of a medical clinic in San Diego. The clinic's founders are accused of hiring "cappers" to bring in Medicare beneficiaries to the clinic so they could submit false claims to Medicare for the services. Another clinic employee, a physician's assistant (PA), allegedly ordered medically unnecessary tests and procedures that were later billed to Medicare. In addition, the PA is accused of "falsely holding himself out as a medical doctor to individuals at the clinic," according to the DOJ press release. To read more about this case, visit www.justice.gov/usao/cas/press/cas10-0722-Kagramanian.pdf.
Part B Insider (Multispecialty) Coding Alert
- Self-Audits:
Know What Benchmarking Against 'Bell Curves' Can Do For You -- And What It Can't
Remember: Chart audits are still your most powerful weapon in the war against miscoding allegations.Medicare's [...] - Modifiers:
E/M Services Call for Modifier 25, But Only When Necessary
You'll be putting your practice in the crosshairs if you misuse this modifier.Knowing when to [...] - Three Conditions Warrant Modifier 25
There are three basic conditions under which an E/Mservice might qualify for a 25 modifier:1. [...] - Check Out the Most Recent CMS Stats to Get Started
Follow the benchmarking guidelines to use this data responsibly.Now that you've read the specifics about [...] - Audiology Coding:
CMS Clarifies How to Report Audiology Services
Look for a physician order for diagnostic audiology tests.If you thought CMS's May transmittal on [...] - Reader Questions:
Catch Up on Incomplete Claims
Question: Our surgical practice has a few claims that have missing or incorrect information. I'm [...] - Reader Questions:
Base Dx Code on Reason for Test
Question: A patient comes into the emergency room for a fall from a ladder, and [...] - Reader Questions:
Modify Eye Codes Just Like E/M Codes
Question: I just started working in an ophthalmologist's office and I have a question about [...] - Reader Questions:
Keep Same HTN Code for Uncontrolled/Controlled
Question: Does ICD-9 distinguish controlled and uncontrolled hypertension (HTN)?Answer: No. Section I.C.7.a of the ICD-9 [...] - Reader Questions:
Clarify Temp Services Using Modifier Q6
Question: Our regular internist is taking some time off, and a temporary internist takes her [...] - Reader Questions:
Get the Scoop on Billing Before Credentialing
Question: Our practice has a new physician coming on board to replace a retiring doctor. [...] - Physician Notes:
Physician's Assistant Accused of Ordering Unnecessary Tests That Clinic Fraudulently Billed to Medicare
Plus: CMS clarifies RAC discussion period vs. rebuttal/redetermination processThe Dept. of Justice not only caught [...] - In other news
If you aren't used to dealing with recovery audit contractor (RAC) requests, you're not alone -- [...]
